The Accidental Veterinarian Page 5

  The young woman who began to unbutton her pants, saying she wanted me to tell her whether the bites she had were from fleas. I declined, saying that all bug bites look the same.

  The woman who brought her budgie in wanting to know why it wouldn’t sing or eat. It was dead. Cue the Monty Python sketch . . .

  The couple who were astonished to find out that their young cat was pregnant. “How could that happen? She doesn’t go outside, and the only male around her is her brother!” (I’m sure every vet has run into this at least once.)

  The woman who phoned and in a very high squeaky voice said, “I have always had the ability to smell cancer. All my friends say I can smell cancer. And I smell it on Billy. I want to bring him in so you can find it and get rid of it.”

  As for the last one, you may not want to read it aloud to the kids:

  The woman who, with an entirely straight face, asked whether venereal diseases are transmissible between humans and dogs.

  And at the end of it all, you should congratulate yourself that you are less wacky than you thought you were.

  The Anatomy of a Vet Bill

  Mr. Malloy was the type of jovial older guy who wore a camouflage cap and red suspenders over an expansive gut. And the type of guy who loved cracking lame jokes. You know the type. Kind of annoying, yet also kind of lovable.

  One day he was at the counter paying his bill when he said, “Holy Dinah! A hundred bucks? You gotta be kidding me? I must own a wing of this hospital by now!” At the other end of the counter, Mrs. Chung was paying her $1,500 bill and quietly exchanging knowing smiles with the receptionist.

  If we had a hospital wing for every client who felt they had paid for one, we would be the size of the Pentagon by now. (Besides, veterinary hospitals generally don’t have “wings.”) But I get it. For a lot of people, veterinary medicine is expensive.

  Some in my profession push back against that statement and say that we just need to look at dentists’ and plumbers’ bills to see that we are not that expensive. No, dentists and plumbers are also expensive, just like us. A lot of modern life is expensive. For many people living paycheque to paycheque (47% of Canadians in 2017), a surprise $500 veterinary (or dental, or plumbing, or whatever) bill is difficult to manage, and a surprise $2,000 bill is a potential financial catastrophe.

  So now that we have established that veterinary medicine is “expensive,” let’s focus on why it is expensive. The number one reason is that we have rapidly evolved to a point where our standards of care compare favourably to those for humans. The arguments about the rightness or wrongness and the whys and wherefores of this evolution are best left for another discussion, but the fact remains that we now practise close to “human-level” medicine and consequently have some “human-level” expenses. There are no special veterinary-grade sutures, catheters, pills, computers, rent or education for that matter. In fact, for many of our supplies we pay more as we don’t have access to the volume discounts that human hospitals do. It is interesting to note that Americans complain about veterinary bills less often than Canadians because they know what human health care costs.

  There are many scary expressions in a practice owner’s lexicon — “audit,” “lawsuit,” “burst pipe,” “crashed server” — but one of the scariest is “overhead.” The others are avoidable, but overhead is unavoidable, and in some practices it can gobble up almost all of the revenue. In my clinic I have calculated that it costs us $400 an hour to keep the lights on, the doors open, the supplies stocked and the non-veterinary staff in place. This is before any veterinarian gets paid. During the busy season this is easy to cover, but in the doldrums of January, when you can hear the proverbial crickets in the waiting room, you may see me obsessively watching the bank balance and line of credit. I might even be chewing my fingernails.

  So where does your money go? In our practice, on a very broad average, for every dollar you spend, about 25 cents covers veterinary salaries and benefits, 21 cents goes to staff salaries and benefits, 27 cents are for variable costs like drugs, supplies, lab charges, etc., and 15 cents go towards fixed costs like rent, computers, utilities, accounting, maintenance, etc. This obviously varies enormously from service to service, and it also varies a bit from year to year. Our veterinarians are on salary, so the 25 cents doesn’t go straight to them, but in some practices vets are paid a percentage of their billings.

  The mathematically astute among you will notice 12 cents missing. That is the theoretical profit, or, more accurately, return on investment, that is divided among the owners (there are seven in our practice) when we have kept a good eye on our overhead. Those of us who own practices have to take out substantial loans to buy them or, in the case of a new clinic, build them, so this money helps slowly pay those loans off. I suppose a theoretical non-profit clinic would be able to lower its prices by that 12% and would have to somehow fundraise to build, expand, etc. It would still be expensive. Veterinary medicine is expensive. But — and forgive the self-serving nature of this comment — it is so worth it. What price can you put on health and love? Especially in a world where people are apparently buying thousand-dollar smartphones.

  Taboo

  It’s the biggest taboo of all. Survey after survey indicates that people (North American people, at least) are more comfortable revealing details of their sex lives than details of their paycheques. For a variety of cultural and historical reasons, it is considered exceptionally rude to ask someone how much they earn. Yet people wonder.

  I think most people believe that veterinarians are reasonably well paid, but not nearly as well as human doctors or dentists. And in broad strokes this is correct, so I could just stop there, but for those who are curious, I will lift the veil more completely. But first a short story.

  We have all said things in the past that make us squirm with embarrassment when we think back on them. I have a veritable catalogue of such statements to draw on, but one in particular is relevant here. When I was a university student, I made one of my then-very-rare visits to the dentist. The dentist was a very pleasant fellow, and we had a good chat about summer plans (well, one of those dental-chair good chats where the dentist asks questions and I reply, “mm, mm, mhmm”). He really was a nice guy, and he did a good job. I don’t recall specifically what was done or what the bill was, but I do vividly recall doing the math on how long I was in the chair and then declaring to my friends and anyone that would listen that this guy must clear $200 an hour (an insane amount in the 1980s)! I was an asshole. And I had done my math wrong — way wrong. Now, 30 years later, I know that “overhead,” as explained in the last essay, is the 800-pound gorilla of the balance sheet. It would have gobbled up a very large chunk of his bill. I still feel bad for implying that he was gouging.

  Fast forward to the present day, when a lot of my day is spent doing ultrasounds, which take around half an hour (although the client only sees 15 to 20 minutes of that as the rest is report writing) and cost around $300. Most people are not as ignorant as I was at 22, but I’m sure there are a few who walk out thinking, “This guy is making $600 an hour! Must be nice.”

  One zero too many. I earn $60 an hour.

  Some clinics pay a percentage of billings, but we pay a straight salary to the doctors. It’s an annual salary rather than a true hourly wage, so there is no overtime or anything like that. As far as I can tell, my salary is fairly typical for a small animal veterinarian in general practice with 28 years of experience. It’s pretty close to the top end for a non-specialist. New graduates start in the $35 range.

  A few of you are probably still thinking, “Sixty bucks an hour — must be nice!” It is nice, and I am not going to complain. But allow me to point out two important factors that make it perhaps less nice than it seems on the surface.

  First of all, we put in six to eight years of university, where rather than working and earning money, we are generating debt. Lots and lots of debt. The medi
an debt on graduation for veterinarians has grown dramatically to $65,000 now in Canada. In the US, it’s $135,000!

  And secondly, most of us do not have company or civil service pension plans. A significant amount of our income has to be diverted into retirement savings to make up for this. At least if we are able to, and if we are smart enough to.

  In the interest of full disclosure, there is another potential income stream. Some of us, myself included, are also practice owners and earn money from any profit the practice might generate (most do generate some, but some don’t). Here, however, there are also two important factors to take into account.

  The first is that profit is not free money. Potential owners have to take out massive loans to buy into practices. This money could have been invested elsewhere, like in the stock market or bonds or real estate, but we have chosen to invest it where we work.

  And secondly, I am part of a fortunate minority to have had the opportunity to buy into the practice. Younger veterinarians are having a harder time affording it because of the aforementioned debt load. Also, large corporations are increasingly buying practices, which prevents the doctors working there from ever becoming owners.

  I know how lucky I am. It’s not a life of luxury, but I never aspired to that, and it is a very good life. I have the trust of the thousands of pet owners who have come to me to thank for that. So, if you are one of those and are reading this, thank you!

  At the Very Heart of It All

  I’ve been in practice for a long time. When I’m asked what the biggest change has been over that time, I sit back, rub my chin thoughtfully, adopt my best wise old man tone, pause dramatically and then quietly say . . . “techs.” Not all the new drugs — in 1990 we had hardly any pain medications we could send home. Not all the new in-house lab equipment — in 1990 we sent most samples away and waited a day or two for results. Not all the new diagnostic imaging equipment — in 1990 ultrasound was not generally available, and X-rays were developed in a darkroom with dip tanks of stinky chemicals. Not all the new dental equipment — in 1990 I used a hacksaw blade to cut apart large teeth that needed to be pulled. Not all the new knowledge, not all the new techniques, not all the new computerization. None of that. These things are important, crucial even, but the most pervasive change that has touched every aspect of veterinary practice is the role of the veterinary technologist (aka RVT, aka registered veterinary technologist, aka animal health technologist, aka veterinary nurse, aka tech).

  To put it simply, since I began in 1990 techs have moved from being overqualified, underutilized animal holders and kennel cleaners to being at the very heart of almost every small animal practice. In 1990 many veterinarians simply trained people in house to perform whatever simple technical duties the veterinarian didn’t want to do himself (and it was usually a himself, not a herself, in those days). The actual college-trained vet techs did very little more than these informal techs, which was a demoralizing and frustrating situation that contributed to a high rate of turnover and burnout. Looking back, it was a bizarre situation. As the veterinarian I took most of the blood samples, placed most of the IV catheters, took most of the X-rays, induced most of the anaesthetics and cleaned most of the teeth, even though the college-trained techs were perfectly qualified to do all of this. I was basically an expensive (although not that expensive in those days) tech for about half my job.

  Today techs do practically everything except what the law reserves for veterinarians, which is diagnosing, prescribing and operating. In our practice, techs take every blood sample, place every IV, take every X-ray, induce every anaesthetic and perform every dental prophy and cleaning. Moreover, they command an in-house laboratory that looks like a miniature version of NASA Mission Control, they perform blood transfusions, they hook up ECGs, they monitor and care for critical hospitalized patients and they counsel clients on weight management, behaviour, post-operative care and a host of other subjects. And they do it all well. Very well. Each one is a medical nurse, an ICU nurse, an emergency nurse, a surgical nurse, a laboratory technologist, a nurse anaesthetist, a dental hygienist, an X-ray technologist, a neonatal nurse and a palliative nurse. All of that, and more.

  In 1990 I could do absolutely everything in the clinic. I knew what every knob on every piece of equipment did, and I knew how to make it do that. I knew exactly how to get blood on every patient (well, almost every patient) and I could wield every instrument and administer every treatment. Today I am more or less useless. OK, I’m exaggerating for effect. More accurate is that I am useless without my techs. Absolutely useless and helpless.

  Most clinics are designed with a large room in the centre called the treatment room. This is where all the action happens. It is the physical heart of the clinic with the laboratory, patient wards, anaesthetic prep area, operating room, pharmacy, dental area and X-ray suite radiating from it. And at the heart of this heart — at the very heart of it all — are the techs. Thank you, Jen, Kim, Mela, Brandi, Marnie, Melissa, Jamie and Jasmine. Thank you for making me so much less useless.

  Cats & Dogs & Paranoia

  It’s dark and it’s quiet in the house. It’s dark and it’s quiet because it is 2:00 a.m. I’m staring at the ceiling, which is pretty boring. I’m hoping that being bored will lull me back to sleep because, really, I would like to be sleeping at 2:00 a.m. I should be sleeping at 2:00 a.m. But you can’t force yourself to be bored. My eyes might be bored, but not my brain. As soon as I woke up, some neuron somewhere in there began ringing the bell. I picture it like one of those old-fashioned “ring for service” brass bells. Sometimes I wake up and everything is quiet in brainland, and I drift back to sleep. But sometimes I wake up and a memory neuron starts hammering on the bell: “Ding! Ding! Ding! Ding! Stay awake! I’ve got something to tell you!” Tonight it was hollering, “You forgot to give that slide to the tech to send away! And it was so hard to get that sample from Callie! Mrs. Levesque is going to be so pissed when you tell her she has to bring that cat back in!”

  Shit.

  Callie was perhaps one of the top ten unhappiest cats in the practice. She could reliably be counted on to growl and hiss from inside the carrier the moment she came into the clinic. Sometimes she was even screaming from in there before we so much as looked at her. Mrs. Levesque had noticed a growth under the skin on her side. After a fair bit of wrangling with leather gloves and thick towels, I had managed to get a sample from the lump with a needle. I remembered transferring the sample to a glass slide in the exam room. And I remembered telling myself that once I was done talking to Mrs. Levesque, I should not forget to take the slide to the lab area for the techs to pack up to send out as this was something I thought a pathologist should look at. I remembered thinking that, but I did not remember actually doing it. Shit. Leaving the clinic that night, I’d had that funny sense that I was somehow forgetting something, but I couldn’t put my finger on what it was. Now I knew. Shit shit. And to make matters worse, Pearl Levesque was one of those brusque, combative people who have a loudly articulated sense of right and wrong and who seem to constantly be on the lookout for the slightest misstep by anyone they deal with.

  Shit shit shit.

  I kept resolutely staring at the ceiling, trying to push these thoughts away and empty my mind. I wasn’t having any luck. Other, more rational neurons kept pointing out that there wasn’t anything I was going to be able to do about it at 2:00 a.m. anyway, but the bell-ringing neurons were louder and livelier. They must have eventually gotten exhausted, though, because at some point I did fall asleep again, fitfully dreaming anxious dreams.

  I once read that psychologists divide people into two broad types: the neurotic and the character disordered. Faced with a problem, neurotics first ask themselves whether they might somehow be to blame and, moreover, they typically assume that the problem is worse than it actually is. Meanwhile character disordered people blame others, or downplay their role or the significance of the problem.
My best guess is that 95% of veterinarians are neurotic. (I’ll let you work out for yourself which professions are dominated by the character disordered.) I’m not really sure why this is, but it does help explain the high rates of burnout, substance abuse and even suicide.

  I entered the clinic the next morning consumed by a sickening sense of dread. I was putting my coat away when one of the receptionists popped her head into the office. “Good morning, Philipp! That unlabelled slide you left in room three last night — I thought I better not throw it out, just in case. It’s in the lab if you still need it.”

  I don’t expect you to be happy if your vet makes a mistake, but before you get too mad, keep in mind that to err is indeed human, and that among humans, veterinarians are usually in the group most likely not to forgive themselves. So it would be great if you could do the forgiving, please.

  In the Dark

  This is not a metaphor. I mean it literally. OK, I’ll confess, sometimes it would be an appropriate metaphor, but that’s not what I’m writing about today. Today I’m writing about the curious fact that I now spend roughly half my time at work in a dark room.

  After ten years in general small animal practice, I could begin to see the rough outlines of burnout approaching on the distant horizon, like a cloud of dust way down a gravel road. I didn’t know whether that cloud of dust signified a puttering tractor or a careening semi-trailer truck, but I didn’t want to wait to find out. It wasn’t anything I could put my finger on, just a growing sense that I needed a different challenge. Don’t get me wrong, general practice is extremely challenging, but it is made up of thousands of individual challenges, case by case, that keep you running like a proverbial hamster on a wheel. But for me, there was increasingly no sense of progress on something bigger.